ARE TUMMY SURGERY COSTS FULLY COVERED BY PRIVATE HEALTH INSURERS?

Private health cover will NOT be available if you do not meet the MBS code criteria. This is because Health Funds rely on you having an MBS item number for cover.  Usually, there will be out of pocket expenses even if you have a good insurance fund. Policies of Health Funds for plastic surgery hospital cover changed to a new tiered-system in 2019. This change may impact your out of pocket surgery costs, expenses and/or coverage for Plastic Surgery. For many insurers,  Gold level coverage is required (please check with your insurer).

IF YOUR WEIGHT LOSS WAS UNRELATED TO PREGNANCY, DOES BODY CONTOURING PLASTIC SURGERY QUALIFY FOR AN MBS ITEM NUMBER?

Excess Skin reduction procedure(s) may be eligible for an MBS rebate if your weight loss was as a result of lifestyle changes or bariatric surgery.

This may apply to Procedures may include Belt Lipectomy, Abdominoplasty or Arm Reduction surgery. Typically, any coverage or rebates only apply if these surgeries are performed as completely separate procedures, as opposed to combined procedures in a single session.

Lipectomy or Skin Reduction in the Abdominal Area

AFTER BARIATRIC SURGERY OR SIGNIFICANT LOSS OF WEIGHT

The Abdominoplasty, Belt Lipectomy and Breast lift Medicare Item Numbers changed in November 2018.

• Effective as of 1 November 2018, Plastic Surgery Medicare Code items and criteria definitions for many Plastic Surgery procedures changed
• This included some body contouring and liposuction procedures, as well as Breast Lift surgery for pregnancy-related ptosis. Read the updated MBS Definitions and criteria

For MBS item Number 30177 your Lipectomy and skin reduction after weight loss or bariatric surgery may be covered if ALL THREE strict criteria are met.

1. there is intertrigo or another skin condition that risks the loss of skin integrity and has failed 3 months of conventional (or non-surgical) treatment, and
2. the redundant skin and fat interferes with the activities of daily living, and
3. the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

This is subject to photographic documentation and proof.

If you are contemplating Abdominoplasty or skin reduction after weight loss which is not related to pregnancy, your coverage may depend on how much skin redundancy you have, and how much these weight changes are contributing to your health conditions. You can contact our Patient Care team on 1300 264 811 to find out more.